2004, 06-25 Permit App: BLD-04-04716 Reroof00"4/4,..
Siokane
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BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
[- Building Permit
❑ Relocation
1 i?ouidi cis
0veV
❑ Change in Use El Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: c eit) biaZ
Phone: S' 71 -5-47 Fax:
Address: 5'77 N 1=w44 s .
'f(-414'1"- LO 99206
City State Zip Code City State Zip Code
El Contractor:
4r -O/2-0413/-& �4 ( 46(1196 -It 0 Architect:
Phone: 146 -art i Fax: Phone: Fax:
Address: /zo't n) 06,;.0..q,6,1 ply Address:
111,zr4y Lc.ICL OA- 99019
City State Zip Code
❑ Applicant:
Phone:
Address:
Fax:
City
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING INFORMATION
. HEIGHT TO I:)jFAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ: FTG:
DECK/GOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS: •
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST qf PROJECT:
toP 42 G,, . , ,
30% SLOPES ON PROPERTY:
SEWER OR ON—SITE SEPTIC
SYSTEM?